Delivering On Accountable Care: Lessons From A Behavioral Health Program To Improve Access And Outcomes.

Patients with behavioral health disorders often have worse health outcomes and have higher health care utilization than patients with medical diseases alone. As such, people with behavioral health conditions are important populations for accountable care organizations (ACOs) seeking to improve the efficiency of their delivery systems. However, ACOs have historically faced numerous barriers in implementing behavioral health population-based programs, including acquiring reimbursement, recruiting providers, and integrating new services.

Tool used to assess how well community health centers function as medical homes may be flawed.

The patient-centered medical home model holds the potential for reducing disease complications and improving health, and the federal government is now promoting the adoption of the model within federally qualified community health centers. In a group of Los Angeles community health centers, we found that all would have qualified as patient-centered medical homes under a widely used assessment tool developed by the National Committee for Quality Assurance and endorsed by the federal government for the community health center program. However, we also found that there was no significant relationship between how well these centers performed on the assessment and whether they achieved a range of process or outcome measures for diabetes care.

Risk factors for thrombocytopenia in HIV-infected persons in the era of potent antiretroviral therapy.

Objective: Before potent antiretroviral therapy, thrombocytopenia was observed frequently. Little is known about risk factors for or severity and consequences of thrombocytopenia since establishment of highly effective therapy for HIV.

Methods: We conducted a retrospective-matched case-control study of HIV-infected adult outpatients with and without thrombocytopenia to elucidate the contribution of HIV viremia, hepatitis C infection, and other potential risk factors for thrombocytopenia.